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Rehabilitation Prescriptions: Are Stroke Survivors Being Let Down?



Tom Balchin - stroke survivor and founder of Action for Rehabilitation from Neurological Injury

In 2010, the Clinical Advisory Group recommended every patient admitted to a Major Trauma Centre ought to have a rehabilitation prescription documenting their rehabilitation needs. Eleven years on, rehabilitation prescriptions are not used effectively and uniformly, to the detriment of patients and those who support them.

Tom Balchin is the founder of Action for Rehabilitation from Neurological Injury (ARNI) who had a haemorrhagic stroke when he was 21. For over 20 years, Tom has committed his life to helping stroke survivors make a functional recovery through a specialist rehabilitation programme that he developed based on his own experience. The ARNI programme is backed by clinical studies and Tom’s methods are endorsed by senior doctors.

Here, Tom talks about his experience with rehabilitation prescriptions and, if used properly, how it could benefit stroke survivors.

What is a rehabilitation prescription?

The idea of a rehabilitation prescription came out of Trauma Services a decade ago. During this time, there was a growing realisation that as patients moved between stages of recovery in acute centres to community rehabilitation, there was frequently a steep fall-away of information available to professionals and patients. This information is deemed to be essential to guide a patient’s rehabilitation to achieve the best outcome.

The rehabilitation prescription should identify the rehabilitation needs and how these needs will be met. It should be started within three days of admission to a Major Trauma Centre by a suitably qualified member of the rehabilitation team, usually a Band 7 physiotherapist. The rehabilitation prescription should be reviewed regularly and kept up to date.

What information should be in a rehabilitation prescription?

From a patient’s point of view, the main focus of a rehabilitation prescription is to document rehabilitation needs and to plan treatment to meet those needs. Neurorehabilitation is multidisciplinary. Core specialties include physiotherapy, occupational therapy, neuropsychology, and speech and language therapy.

The rehabilitation prescription ought to contain information on different aspects of recovery including:description of injuries/illness, psychosocial background, treatment received, clinical restrictions and individual rehabilitation needs.

There should be sufficient information for each specialist in the multidisciplinary team to plan and deliver ongoing rehabilitation to maximise the potential for an optimal outcome.

Who should receive a rehabilitation prescription?

The patient and/or family, as well as their GP, should receive a copy.

However, as Professor Mike Barnes, ABI Alliance Chair, has rightly noted: ‘the rehabilitation prescription has no value if the individual with an acquired brain injury and their GP don’t receive a copy. If the individual and the GP don’t know what rehabilitation is preferably required, then no access to services can be planned or implemented’.

There is a feeling, clinically and in the community, that the use of rehabilitation prescriptions is sporadic.

Why are rehabilitation prescriptions important for stroke survivors?

When the patient reaches the community, outside of the realm of NHS help, a rehabilitation prescription that can be used to guide ongoing rehabilitation is ideal. Some patients, or most often their families/carers, are very careful to keep as much information as they can.

Unfortunately, patients often seem to travel away from the clinical remit without copies of discharge notes and with no guidance about ‘what to do’ when they return home.

Especially during this pandemic, when disruption to health and care services has meant that national stroke initiatives across the country have been paused or slowed, it’s not surprising this is the case.

With innovative solutions being implemented to tackle disruption to stroke services, are rehabilitation prescriptions as important as ever or not?

Rehabilitation prescriptions would seem to be even more important during this pandemic.

This is because for patients who have gone without, or had very little therapy, and have the means to afford private support, a rehabilitation prescription would be ideal to guide an independent therapist or trainer.

A Stroke Association survey last year of almost 2,000 survivors makes interesting reading. The number of stroke survivors who had therapy cancelled or postponed was very high – 44 per cent had appointments related to their stroke online or over the phone during the pandemic and 28 per cent had therapy online or by phone.

Unfortunately, virtual methods of healthcare have not been viable for all. The number of stroke survivors who had therapy cancelled or postponed is double the number who received therapy online or over the phone pre-pandemic.

This shows that many have not had their usual rehabilitation support, but with a rehabilitation prescription, would at able possibly to have been supported into some kind of community-run therapy, possibly delivered by the third sector.

What is your experience with rehabilitation prescriptions in stroke survivors?

They basically don’t happen. Even now, senior clinical therapists around the country have only heard rumours about them being created and are not clear what form these would take.

I spoke with Avril Drummond, Professor of Healthcare Research at Nottingham University, about rehabilitation prescriptions for stroke survivors.

Professor Drummond is well versed in the national situation and forthcoming initiatives in stroke. After enquiring with colleagues for a few weeks about rehabilitation prescriptions for stroke survivors she ‘drew a total blank’.

Further questioning to the National Leads revealed they ‘don’t know’. If the National Leads don’t know, then we can be quite sure nothing is going to take place on this any time soon. This is a shame because it would be invaluable for a patient to know any trainer or therapist they work with can access to a simple ‘passport’ containing up to date information on their rehabilitation needs.

Ideally, a rehabilitation prescription would be updated as a patient advances in their life after stroke. The rehabilitation prescription would be accessible by other rehabilitation professionals. Assisting professionals is essential to achieving the best outcome in the most efficient way.

What is required to ensure rehabilitation prescriptions are used effectively?

There needs to be a comprehensive national rehabilitation strategy to roll-out rehabilitation prescriptions as a requirement to give to patients and professionals. This would provide clear information to refer to as patients move from acute services to community services and beyond.

Tom Balchin is founder of The Arni Institute – for more information, visit He was speaking with Hokman Wong, senior solicitor at law firm Bolt Burdon Kemp and a specialist in adult brain injury claims.


Learn more about virtual reality in rehab

Event is an opportunity to hear from expert Dr Katherine Dawson, Consultant Clinical Neuropsychologist.



An event later this month will give neuro-rehab professionals an opportunity to learn more about the use of virtual reality in the field. 

The virtual webinar, on 26th January at 1.20pm to 2.30pm, features an in-depth talk by Dr Katherine Dawson, Consultant Clinical Neuropsychologist.

A Guide to Virtual Reality, which can be booked by emailing, will cover:

– Growth of digital health

– Virtual Reality(VR) / Telerehabilitation evidence base

– Virtual tour of the Brain Recovery Zone VR platform

– Where does the Brain Recovery Zone sit in a clinical pathway

– Clinical outcomes, case studies, and research trial

Dr. Katherine Dawson has over 15 years experience working in various rehabilitation settings (both within the NHS and private sector) with individuals who have a wide range of neurological conditions.

She has a particular interest in cognitive rehabilitation, and working with individuals and families to manage emotional and behavioural changes following Acquired Brain Injury (ABI).

She is currently involved in research with the NHS regarding ABI and telerehabilitation, and has recently published a book exploring adjustment to brain injury from the perspectives of clients, family members and clinicians. 

In December 2017, Katherine set up a local neuro-rehab service (Sphere Rehab) with her business partner, focusing on community integration post ABI. She also co-founded the Brain Recovery Zone neuro rehab Virtual Reality platform in the summer of 2019. The team are commissioned by several local CCGs and also work within the private sector.

Ahead of the event, she said: “I just wanted to say a massive thank you to Think Therapy 1st for inviting me to talk about VR and the Brain Recovery Zone. Virtual Reality has great potential in neuro rehab – both to ‘up’ the dosage of rehab, in addition to promoting ongoing engagement and self management.

“I am really looking forward to delivering this webinar and discussing some of the clinical outcomes including the work completed together with Think Therapy 1st and other clients.”

Helen Merfield, Managing Director, Think Therapy 1st, which is organising the event, said: “I am really excited about our VR event we have used Dr Dawson on a number of cases with amazing results and her VR really has changed lives.

“So much so that we are partnering with her company Sphere as a preferred provider for both VR through Brain Recovery Zone and Clinical and Neuro psychology. Close working ties can only improve outcomes which for both our companies are already impressive.”

To register for the event email


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Sport and exercise ‘have key role in mental health and wellbeing’

The Moving for Mental Health report highlights the role of physical activity in supporting mental resilience and recovery



Physical activity and sport can play a key role in supporting mental health and wellbeing and helping people to recover from the ongoing impact of the COVID-19 pandemic, a new report has concluded. 

The Moving for Mental Health report includes better training for health professionals to prescribe movement as a means of effectively tackling the vast growth in people experiencing mental health issues. 

Produced following the onset of the pandemic, the report sets out evidence that developing a healthy relationship with physical activity and being involved in linked programmatic interventions and social networks is beneficial, can improve people’s mental health and wellbeing, and help tackle social isolation.

The project, by the Sport for Development Coalition and Mind, highlights how COVID-19 has exposed the weaknesses of single-sector responses to addressing complex mental health problems and tackling growing health inequalities. 

The report recommends physical activity and community sport be further embedded in health policy and integrated care systems while calling for an enhanced role for experts by experience and diverse communities leading in the design, implementation and evaluation of future strategy and programming.

Launched at an online meeting of the All-Party Parliamentary Group for Sport, it is also designed to support and inspire public bodies, funders, commissioners and policy-makers as well as community-based programme providers aiming to enhance the impact of movement for mental health.

Paul Farmer, chief executive of Mind, said: “While Mind’s research suggests that half of adults and young people have relied on physical activity to cope during the pandemic, we also know that physical activity levels for people with long-term health conditions, including mental health problems, have declined. 

“Considering how vital physical activity is for many people’s mental health, it is clear that we need a collective effort to reach those who need support the most.”

Andy Reed, chair of the Sport for Development Coalition, said: “This report is aimed at supporting and informing policy-makers about how we can maximise the contribution of targeted sport and physical activity-based interventions at this crucial time.”

The research was led by a team of academic researchers from Edge Hill University and Loughborough University, and draws on evidence and submissions from over 70 organisations including sport and mental health organisations, public bodies and Government departments.

Andy Smith, professor of sport and physical activity at Edge Hill University, said: “The impact of Covid-19 on people’s mental health and wellbeing cannot be overstated. 

“It has brought to light the significant mental health inequalities which existed prior to COVID-19, but which have since worsened further, especially among those living in under-served and low-income communities. 

“Our research is calling on the Government and other public bodies to invest in the provision of movement opportunities for mental health across multiple policy sectors, and to use the evidence presented as a basis for making more effective policy decisions which benefit everyone’s mental health and which tackle deep-seated inequalities.”

Moving for Mental Health is the first policy report in a series being published throughout 2022 by the Coalition and relevant partners. The reports are aimed at maximising the contribution of targeted sport-based interventions to helping ‘level up’ communities facing disadvantage and deprivation and tackling deep-seated health and societal inequalities which have been exacerbated by COVID-19.

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Calvert Trust announces new trustees

Louise Dunn, Judith Gate, Emily Flynn and Victoria Notman bring their expertise to the Trust, which also runs Calvert Reconnections



The Lake District Calvert Trust (LDCT), which runs brain injury rehabilitation centre Calvert Reconnections, has started 2022 by announcing the appointment of four new trustees.

Louise Dunn, Judith Gate, Emily Flynn and Victoria Notman will bring their respective expertise to supporting the further development of the charity and its vital services.

Louise Dunn

Louise Dunn is a communications consultant and academic with over 25 years’ experience of management and leadership roles in the pharmaceutical industry and at Alder Hey Children’s NHS Foundation Trust and Charity.

Commenting on her appointment, Louise said: “As a Keswick resident, I’m delighted to be able to get involved with this extraordinary organisation, that has such a positive impact for people living with disabilities in our community and all over the UK.

“I am looking forward to learning more about how I can help the team and contributing to their exciting plans for the future.”

Judith Gate has extensive experience in the charity and public sectors including leading the volunteering and customer care functions for a national charity.

She currently leads a continuous improvement programme with a focus on delivering efficiency and improved customer experience through business process improvement and digital transformation.

Judith Gate

Judith said: “I applied to be trustee because I wanted to use my skills to deliver as much positive impact as possible. As an outdoor enthusiast I feel a genuine connection to the Calvert Trust‘s mission of making outdoor activity accessible to everyone

“I am really excited to join the board and look forward to using my knowledge and experience to help support the Trust achieve its ambitions over the coming years.”

Emily Flynn has over 21 years’ experience as a military officer and communications-electronics engineer across a wide spectrum of business areas including: senior leadership/board-level management; digital optimisation; resource planning; engineering, operations and risk management; trusteeship; and mountaineering leadership.

Commenting on her appointment, Emily said: “I am delighted to become a trustee of the Lake District Calvert Trust.

“The military introduced me to the benefits of outdoor education as a means of expanding personal confidence and stretching comfort zones in a controlled environment. It also led me to become a mountaineer.

“I hope to be able to bring my previous experience as a leader, mountaineer, engineer and trustee to help the Calvert Trust

Emily Flynn

continue to deliver amazing outdoor education to its participants and to help it grow over the next few years.”

Victoria Notman is legal director at the employment team at Burnetts Solicitors in Carlisle and has over 20 years’ experience as an employment lawyer.

She also has a first-class honours degree in physiotherapy and experience in the rehabilitation and development of adults and young people with mild to severe physical and mental impairments and learning needs.

Victoria said: “I am looking forward to applying my knowledge and skills to become integrated into the fabric of the Trust to such a degree that all the experience I have to offer can really make a difference to the lives and happiness of those accessing Calvert Lakes and Calvert Reconnections.”

Welcoming the charity’s new trustees, Giles Mounsey-Heysham, chairman of the LDCT Trustees, said: “After a detailed recruitment process, we are delighted to welcome our new Trustees.

Victoria Notman

“Together they bring a wealth of skills, experience and shared passion to the Lake District Calvert Trust. We welcome their contributions moving forward.”

The Lake District Calvert Trust has been supporting people with disabilities from its specialist Calvert Lakes residential centre and accessible riding centre near Keswick in the Lake District for almost 45 years.

Calvert Lakes has grown from being the UK’s first dedicated activity centre for people with disabilities, to welcoming around 3,500 visitors to stay each year.

These include individuals, family groups, specialist schools, accessible sports clubs, disability charity groups, supported living organisations and care homes across the UK.

Last year, the charity also opened Calvert Reconnections, the UK’s first residential brain injury rehabilitation programme combining traditional clinical therapies with physical activity in the outdoors.

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